Debate Over Removal of Online Malpractice Database

A testy debate has arisen between journalists and consumer rights groups and the American Medical Association (AMA), over the availability of doctor's disciplinary information. The Health Resources and Services Administration, a branch of the U.S. Health and Human Services Department (HHS), recently removed such information from a public, online database after a number of news organizations used the National Practitioner Data Bank (NPDB) to identify physicians who had been frequently accused of medical malpractice but had not been disciplined.

The NPDB is an information clearinghouse containing information on payments in medical malpractice cases and clinician disciplinary actions. It was created by Congress to improve health care quality, and is managed by the Health Resources and Services Administration (HRSA). Health care organizations, including hospitals, health plans, and state licensing boards may review NPDB information when considering a practitioner for clinical privileges, employment, or licensure. A public data use file is available on the Internet to the general public, as well as news organizations. However, the file does not contain physicians' names or addresses.

Nevertheless, journalists have used NPDB data along with other resources to identify doctors accused of malpractice.

The HRSA defended its actions in protecting doctors' anonymity. HRSA spokesman Martin Kramer explained to Medscape Medical News that "federal law mandates that information about individual physicians remains confidential. We have a responsibility to make sure federal law is being followed." The AMA supported HRSA's decision. It has maintained that the public use database is not a reliable source of information and is an inaccurate indicator of a physician's competence and qualifications.

It remains to be seen how the NPDB removal will affect patient safety. Detailed reports are not available to the public, and the information that is public domain does not identify any specific doctor or organization. Also, plaintiffs are only allowed access under limited circumstances, such as when a medical malpractice claim has been filed, and the hospital has failed to provide such information about the physician.

Meanwhile, many state licensing boards collect detailed information about doctors' professional information and make such available to the public. The Pennsylvania Department of State maintains a database of licensed physicians, therapists and other healthcare professionals that contains information about when a medical license was issued, as well as whether disciplinary action has previously been taken.

Also, holding physicians accountable for mistakes requires more than access to past disciplinary actions. Indeed, such information would identify a pattern of malfeasance (and suggest that a hospital failed to conduct due diligence checks), but a medical malpractice claim hinges on specific mistakes in treating a patient. Therefore, an attorney would review all information recorded in the patient log to ensure that all safety protocols set forth by the Joint Commission were followed.

For example, every surgery requires confirmation at each stage of the procedure. At the pre-procedure check-in, a nurse confirms the patient's identity, marks the surgical site and confirms the presence of the patient's medical sheet. Before administering anesthesia, the anesthesiologist ensures that no allergic reactions occurred, and that the patient's vitals were steady as medicines took effect. Before the surgery begins, all team members are introduced, and the procedure is discussed along with the steps anticipated steps. After the surgery, the team would confirm that all surgical tools were accounted for, record any problems during the surgery, and note any details for recovery.

In the meantime, researchers can still access the malpractice data by contacting the NPDB directly and requesting information. The HRSA may repost the data online after it includes additional protections to prevent future confidentiality breaches.

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